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Subject:
From:
Lisa Marasco IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 26 Nov 1997 19:09:24 -0800
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Dear Lactnetters,
I'm discouraged. I've had what seems like more than my share of mothers
with milk supply problems. The past six months I've been researching
possible pathologies with regards to PCOS and uncovered some promising
clues, but then there are the mothers who don't fit into *those*
parameters, either.

I've got a young, fifteen year old mother whose milk has not come in very
well so far at 6 days; her idea of "full" (milk in)at 4 days was my idea
of moderate feeling breasts, and she has never pumped more than 1/2 oz.
Baby was 3 weeks early, small (in the 5-lb range now), and not latching
on consistently. Mom is so discouraged between baby not latching and milk
not coming in well that she is almost ready to toss in the towel despite
*wonderful* grandma support.  Mom is heavy, reports having had weird
menstrual cycles since age 10, more around every 2 months. She reports
some breast growth during pregnancy. Induction due to pre-eclampsia, mag
sulfate, pit and ITN (with morphine, then benadryl afterwards for
reactions.

A thirty-something mom, infertility patient, now at 2 weeks pp, breastfed
from birth but baby not really getting anything, lost weight, jaundice
levels climbed.  We instituted pumping and she has never gotten more than
1/2 oz, either, despite the pumping and use of More Milk (fenugreek made
her sick). This mom was also induced with pit, had nubane and ITN. She
called me today to say that she and her husband talked, and with the lack
of change in production despite all her work, they feel that this is
hopeless and will stop pumping.

Another mom, late twenties, Filipino, called at 48 hrs worried that her
baby wasn't getting enough to eat despite going to the breast
"constantly".  At 48 hrs baby had lost 10% of birth weight, but was
strong, alert and vigorous. Meconium poops of first day had slowed to
small quarter-sized patches the second day, no wet diapers. Mom's breasts
are comfortably firm, but I could not get so much as a drop of colostrum
out of her by manual expression, not even a hint of moisture. Baby's
frenulum is attached just behind the tip of the tongue, yet at breast and
on finger displays excellent suck.  No swallowing, baby seems more and
more frustrated. I don't think he's getting anything, either, and due to
the weight drop instituted a small amount of supplementation to be
offered at the breast until (I hope) mom's milk comes in. Mom's history
completely normal, breast growth from 36A to 38C, but absolutely no
leaking or signs of colostrum at any time during pregnancy.  I have more
hope for this mom than the other two.

These are just three recent cases.  Retained placental fragment has been
ruled out, MD reports sent to notify doctors of the problems, and yet the
OBs are extremely casual (one hasn't called back the mom since last week)
and unconcerned.

Of the cases that I've identified possible etiologies, I am having a
difficult time getting pediatricians/endocrinologists/obstetricians to
care enough to help research the issues.  There are some possible
therapies, but babies would need to be monitored as this would be a new
application, and no one is the least bit willing to look at this.

Again, I am discouraged. I am seeing too much unexplained insufficient
milk. The moms come in early and get the best of help, yet the milk just
doesn't come.  No heavy bleeding, no horribly unusual meds; what is it?
And why do OBs put off checking the mom out until she has given up (which
most often occurs before her six week check up)?

-Lisa Marasco, BA, IBCLC

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